Question 13 and Question 14 both relate to the following clinical scenario:
A 71-year-old man is transferred to your intensive care unit following a mechanical aortic valve replacement and coronary artery bypass surgery.
The anaesthetist reports that he came off bypass readily, has not required any inotropic support, and has epicardial pacing wires in situ. However, shortly after arrival his blood pressure falls to 60/30.
Question 13 was as follows:
a) Outline your differential diagnosis for his hypotension
His blood pressure improves rapidly with a fluid bolus, and examination is otherwise unremarkable. However, he is noted to lose 250ml of blood from his mediastinal drains over the next 30 minutes.
b) List 4 likely causes of, or contributors to, excessive post-operative bleeding in this setting, and outline your immediate management.
Question 14 continues from the above.
Twenty four hours later, he develops a new-onset tachycardia as shown in the ECG below. (again, the college has removed the images from their paper, but I have found an alternative (hopefully equivalent) image)
a) What is your interpretation of the ECG?
b) Outline your initial management of the tachycardia
c) List 3 primary non-cardiovascular causes of the above tachycardia.